Mahjong Clinic Special is a follow-up to Mahjong Clinic: Zōkangō, and has a similar theme and gameplay system. The player controls a school principal who brings female students to the hospital to do some tests. The player can then select various hospital rooms on a map; traveling to these locations triggers short conversations, which invariably lead to mahjong games against nurses, schoolgirls, patients, etc. A separate game mode is available, allowing the player to directly compete in mahjong against opponents from the story mode.