OTK Meetup 13/2/2015–Clinic Meetup Report @ OTK Cheras 13/2/2015– CLINIC
By jack208

Been awhile since I put in a sessrep. Here’s a lengthy one on CLINIC, the Town Center designer Alban’s most recent game from last Essen. We also did SAMURAI SPIRIT, LA ISLA and PANTHALOS among other games seen in-play tonight at OTK.

OTK on Friday Nights

It has been awhile since I last put fingers-to-keyboard and wrote a sessrep of our Friday OTK Meetups. The meetups are still continuing regularly and while I’ve been remiss on the reports, I do post as many pictures as possible. Hopefully I can clear most of my other (overwhelming) backlogs soon and get back to one of the few things I love to do most – writing sessreps of boardgames I’d played.

Last Friday (13/2) was the last meetup before we break for Chinese New Year, and while I’d expected some regulars not to be around (busy preparing for CNY?) the crowd was replaced by some newer gamers (some of whom TBH I’ve not made my acquaintance yet!)

SAMURAI SPIRIT (Antoine Bauza)


When I arrived at OTK (late as usual), I saw Hiew already doing SAMURAI SPIRIT on one of the tables. His village suffered badly in his last play so I presumed he’s back for vengeance against those bandits. When I asked him how he was doing, he put it rather succinctly. haha.

“Our kampung koyak on both accounts. But this time both were because one of our warriors got killed. In the first game the kampung was quite badly burnt by Round 3. We probably wouldn’t have been able to handle the remaining robbers even if none of us got killed. In the second game we actually protected our barricades and houses quite well up till end of Round 2, but one of us got killed, so we didn’t even make it to Round 3.”

I’ve heard similar comments from others who played this coop game. It does appear Antoine Bauza has done a great job with his 2014 title Samurai Spirit, a coop game that requires a few (or maybe even more) villages to be burnt down before you can crack it.

LA ISLA (Stefan Feld)

On the next table, I saw Feld’s LA ISLA in session. The influx of new games from last Essen meant OTK has not seen many Feld games on the tables recently (given the large collection of games he has designed) so it’s good to see one of his most recent titles in-play.


LA ISLA looks like one of his lighter games.

CLINIC (Alban Viard)

I’d initially booked a copy of Alban’s – he of Town Center fame – limited CLINIC sets last Essen (2014). He only printed 200 copies last Oct. However I’d misunderstood his instructions for picking up the games in Essen and missed our appointment (duh!) I was kicking myself until Alban relieved me of the misery by announcing a second salve of CLINIC, also limited print run but this time with two expansion modules (he calls them Medical Dossiers). So turned out my “miss” was a blessing in disguise.


Above: We’ve the Health Minister (that standing fella) overseeing our progress at hospital management. Hmm, he didn’t look too impressed with our performance.

The game (and expansions) arrived some time back, and it’s only this week that I managed to have time to go thru the 8-page but well-written rule book. You might think given the rule book is only 8-pages, this is relatively a light medium game. It’s not. The reason I mentioned the rule book’s well written is because CLINIC introduces many different new concepts into the game – the only slight similarity with Town Center is the 3D element of building rules – and yet can cover them well within the 8 pages.

Note: I intentionally avoided the use of  the word “mechanics” and chose to replace it with “concepts” just so I can troll Hiew’s recent post “Mechanics or Mechanism?” tsk tsk.

CLINIC plays up to 4 (it has a solo mode too) and it’s as close to SimHospital as you would find in a boardgame. I think it’s probably the ONLY hospital theme game (correct me if that’s not the case). You compete with 3 other land owners to build the “best” hospital to serve the folks of Town Center. Your “land” happens to be a 4×3 plot – not much space to grow horizontally – which means you’ll need to contemplate building upwards very quickly. And this is where Alban extended the 3D elements of his Town Center game except in CLINIC, you do not actually build in 3D but in a 2D board representing a 3D structure (ie a flat player board depicting the land and up to three storeys high).

And if you think 4×3 is small… wait till you flip the player board over to check out the 3×3 board which is for the pros!


Each player starts with the same amount of resources – 15 coins, one level 1 (L1) doctor (large white cube) and building blocks to set up one active functioning Psychiatric treatment room. Beside Psychiatric there are 4 more medical services you can provide for such as ophthalmology, medicine, surgery and cardiology. You’ll get the chance later to add other treatment rooms to extend your services but as with all booming new town centers, mental illness is always the first to appear. We are after all, nutcases.

Each player also gets to choose one bonus starting tile that grants a different bonus item (an extra doctor, more money, a parking lot etc) to introduce some differences in the starting setup but basically from the word-go we are all competing for the same batch of psychiatric patients until we build other types of treatment room to extend into other Services.


Above: I made a mistake in building my initial set of rooms “away” from the (right) edge. This limited where I can add new entrance(s) later and would impact the flow efficiency of my hospital.


Why is flow efficiency important? CLINIC is not a typical worker placement nor a point-salad game. It’s also not a game about building the “best” hospital  (ala Town Center) though doing that would help your cause. CLINIC is a game about building the most advanced hospital that’s able to handle the incoming admission queues as efficiently as possible, thereby raking in the most profit which in turn affords the highest amount of Popularity points (that’s the VPs to win the game).

I know my description above over-simplifies the game. There are layers to the game that one only appreciates after playing thru a session. Let’s dive in for a closer look.


From a surface level, the game is about making enough money to build the most advanced hospital in all of Town Center…. hopefully a hospital that’s equipped to deal with all ailments (there are 5 different medical services). The base game has only a few different building blocks (above) so they are not hard to grasp. There are also specific building dos & don’ts that restrict your building plan but everything is very manageable at this stage. This is also where similarities to Town Center start…. and end.

The 15 coins you started with won’t last long as building costs are not cheap and they get more expensive as you build higher up from ground floor (and you have to since your land is only 4×3). Therefore you need to be able to admit & treat incoming patients – well, if you have a fancy hospital but no patient, you ain’t gonna see much profits – and to make decisions to improve your hospital according to the future demands of the various medical services.

As your hospital grows larger, you would want to look at optimizing the human traffic flow as you shuffle all the necessary elements – patients, doctors, nurses, treatment rooms – in order to get the right patient to the right treatment room with the right doctor (level) and/or supported by the right number of nurses. Each movement of any of these folks from one block to another costs you 5 min; and every 15 min costs you to lose 1 VP (at end game).


Above: The Patient Services & Pre-Admission Queues where you can pull-in patients to your hospital for treatment (and ka-ching, profits!)

The Patients are drawn from a bag (seeded with a pre-set mix of different severity levels of patient. Severity level is denoted by colors – white being the least serious and red is critical ie if this patient is not treated this round, he’ll simply…. die. And you do not want to have a patient dying in your hospital as it’ll cost you to lose 3 VPs.

Obviously the more severe the condition the more fees you can collect for treating them. White patients (L1) fetch only $8 while the critically ill red patients (L4) bring in a cool $32.  New Patient cubes are added into the game via the Service Queues (above) in a way not unlike the Production tables in Age of Steam. Do note that Alban, the designer has released a number of Age of Steam expansion maps prior to this game. Unlike Age of Steam where the cubes are seeded thru dice roll, in CLINIC, there’s a pre-set series of color cubes (based on player count) for eg in our 4-player game. the bag would start with 34 white, 24 yellow, 16 orange and only 6 red.

A new batch of patients would keep streaming into the Service queues (the four columns on the left) turn after turn, so you do get some look-ahead. However with three other competing hospitals vying for the same patient cubes, your work is really cut out for you.


Patients in the Service queues do not automatically move to your hospital – after all they are just saying they are down & ill, they have not decided which hospital to go to. You need to attract them into your hospital by pulling the patient over from the Service queues into your Pre-Admin queue (each player has their own Pre-Admin queue – on the right – which can have 4 waiting patients for each service).

You have to have the matching Treatment (Service) module in order to pre-admit a patient from that Service queue ie to pull the (most wanted) red patient from the 2nd service queue which is Ophthalmology, you need to have an active Ophthalmology service/treatment room in your hospital.

TREATING THE PATIENTS or Orange-with-Orange otherwise Nurses are very helpful

You need to match the color of the patient (indicating severity) with doctors with the right experience level (matching the patient cube in color) for a successful treatment. Nurses (blue cubes) are used to bridge the difference between colors – each level of difference can be bridged by one nurse cube. Eg a white doctor (being someone junior) can treat a white patient and you’ll need very experienced red doctors to treat the red critical patients.

When the patient & doctor are not matching, you can mitigate the gap by supporting the (mismatched) doctor with nurses; one nurse for each level of difference (upwards or downwards) so if you have only a white doctor (L1) but need him to treat a yellow patient (L2), you need to support with just one nurse (blue cube).

No matter how well you planned, it’s unlikely you’ll always have a matching doctor for each incoming patient. As such, having some nurses on your payroll helps give flexibility to your plans. This is the resource & set management part of the game.

Why an experienced red doctor can’t treat a non-critical white patient without requiring three nurses in attendance?

Note: We misplayed the “Swap Patient” rule. We wrongly played that you can swap with any queue which negated the advantage of building a diverse Service portfolio in your hospital. The rule said you can only swap with adjacent queue. This would make Patient Admittance more challenging to execute. It also makes the option building additional Service modules more attractive (or even necessary) since this opens up more queues for you to choose your patients from.


Patients in the Service queues are not under your obligation but once you pulled them into your Pre-Admittance queues, you are committed to treat them (or lose them). Patients in the Service queues are however available to everyone so either you pull them into your hospital for pre-admittance or one of your competitors would.

If they are not treated in this round, their condition degrade – and while you may think that’s good coz it mean higher fees, you need to consider if you have the correct set of experienced doctors / nurses to deal with more critically ill patients. You do not want them to die while waiting in your pre-admittance room, do you? 😛

The challenge of bringing not just the patients, but also the correct combination of doctors & nurses into the appropriate treatment rooms is where you need to build a hospital that optimizes human traffic flow. A busy hospital is good, but one where people are running around helter-skelter is not going to help you win the Popularity awards. 😛

Let’s look at an example (below) of the concept of movement points.


My hospital’s just opened for biz and I’ve some incoming folks I need to move around to get them into the right place within the hospital. The pink cube is an admin staff who needs to be moved to the office room (which is the pink building block in the 1st floor, middle of the player board); this would cost me “15 min” by default as the staff needs to walk past two rooms (5 min ea) and then walk up a flight of stairs to the office room in 1st Floor. However I’d built an elevator (the grey round discs connecting the blue room in GF and the office room in 1F) which saved me the 5 min walk-up-the-stairs so the movement of the staff cost me “10 min” instead.

The smaller yellow cube is a patient (with severity L2) and if I can get him into the Psychiatric treatment room (the blue room in the middle of ground floor) with a yellow doctor (same level L2) to treat him, I’ll earn $12. A critical patient (red) would have earned me a more lucrative $32 but then I would also need doctor/nurses of the right level to treat him.

Therefore moving both the patient (smaller yellow cube) and doctor (larger yellow cube) into the treatment room (GF) would cost me another “20 min” (10 min x 2).

I have an extra doctor (from my starting bonus tile) and since there’s no further patient to treat – and I’ve built a learning lab (the tile above the treatment room) – I can send him there to learn/improve himself (which is indicated by him changing from a white L1 to orange L3 doctor next turn). The move to the learning lab would cost me a further 15 min (5 min x 3 spaces from entrance).

My total movement points for the 1st round was 45 min.

And this is only in the 1st Round where we have the basic Psychiatric ward and one or two extra rooms built. Imagine the challenge in optimizing all these human traffic flow when you have treatment rooms in multiple floors – or even different buildings.


Above: The Elapsed Time tracker that’s used to track how many hours/minutes each player has spent shuffling people around his hospital. At the end of the game, each 15 min deducts one VP.

The observant may have noticed the game plays over 6 rounds, and the Time Tracker shows up to 6 hrs. Does this suggest we should try not to exceed 60 min of movement points per round? Maybe. Maybe not. I think what’s important is not so much how many minutes you’ve spent but rather what are your returns from those “lost minutes” (since every 15 min block costs you 1 VP). The “1 VP loss” is relative since everyone’s also moving their people around their hospitals.

To quote an example, in one of the turns I took about “70 min” to position all the people (doctors/nurses/patients) into the right treatment rooms and made around $52. One of the other players took less than 35 min and made around the same revenue. I’d lost “2 VPs” – for the 30 min difference – in that turn for being less flow efficient than my opponent. Unless my positioning allowed me to leverage on the sunk cost in future rounds.

That’s why flow matters in this game.


While I’ve explained where you get your patients (from the Pre-Admin queues described above), where do you look to hire good doctors? The medical university, of course. 🙂

Each round there’ll be a number of graduating doctors – some less experienced (white) and some with better experience/skills – that’ll be added to the University Pool (below, two yellow and three white doctors ready-to-be-hired).


There are only 5 doctors available each round (for a 4-player game) and you need doctors in order to treat more patients (doctor to patient is always one-to-one) so there’ll usually be fierce competition especially to get the more experienced ones. Doctors not-hired in this round, if left in the university would continue their “education” and improve their experience level (by one) for the next round, making them more attractive to the hospitals.

Note: In our session, we missed the “doctors improving their experience if left un-hired in the university” rule so this affected the dynamics of the game by making the decision to hire or not hire an easier one to trade-off. If the correct rule is played, then “waiting” another round may get you better doctors but at the risk, one of the other hospitals grab an inexperienced one since they may be able to augment the lesser experienced doctors with nurses or maybe they have their own learning labs to train up the new doctors.

Which leads us to the next topic – nurses!


There are two other resources that you’ll certainly need to consider to help manage your growing hospital business. Staff (pink cube) are general workers who help you to run your hospital more cost-efficiently. There are only a limited number of staff cubes – and they do not increase over the game. So if you need more staff for your hospital, hire them early.

Nurses are the blue cubes, and while you may think them of lesser importance to doctors (since patients are only treated by a doctor), they provide much needed flexibility (in treatment execution) since you need to juggle and optimize movement points between treatment rooms, doctors and patients at all times. When you have a mismatch pair of Doctor-Patient, nurses help you to close the gap (one nurse per gap).

Nurses could be the difference between successfully treating a red patient (L4) with an yellow doctor (L2) for $32 or letting the patient die in your hospital (not a good thing popularity-wise). If the latter happened, you do not just miss out on the $32 revenue but also lost 3 popularity points (VP) – no one wants to be admitted to a hospital where a patient just died.

EVERYONE DRIVES and the challenge of car parks

The last challenge Alban threw at us is a problem that’s very familiar with most Malaysians…. where do you park your cars? 😛 Every single cube you pull into your hospital – be they Staff, Doctors, Nurses and even Patients – come with their own car (represented by a black cube). And your hospital needs to provide a space for them to park their cars!!


Parking spaces obviously have to be provided in the ground level and on roads where you have cars parked, you lose the ability to construct building blocks (see the spaces marked by “X”). Landed space is already a premium to start with, and losing them to provide car park is another setback you need to manage.


Above: A busy period in my hospital with 10 cars (two in the parking lot and the rest by the roadside)! With so many cars scattered around my grounds, I was literally running out of space to build any more rooms on the ground floor (part of that was due to my badly placed start buildings away from the right edge). You can mitigate the car park problem somewhat by erecting “car park building” which allowed two cars in a landed space (see example above). There’s an improved car park building that allows up to 3 cars to be parked.

The cars (black cubes) represent “waste” and is a necessary by-product of a thriving hospital business. You won’t be completely removed of this problem; you can only hope to manage the situation as best as you could. Look at it this way; if your hospital ground is devoid of cars, it probably meant your hospital business is not doing well.

Here’s a look at how the other hospitals managed their car park issues in our session.


Above: Dith’s hospital lined them cars in a row! He mainly build upwards (narrowly) and had plenty of parking spaces until the later rounds when he started expanding into a 2nd building.


Above: Ivan clustered all the cars in one corner… hidden from sight. haha.


Now, this (above) would have solved all our car park problems!! Is Alban going to release this as an Expansion Building Tile? LOL.

The only consolation in the car park issue is that when a patient has completed his treatment, he pays the hospital and then leaves… with his car! Even the “dead” take their cars with them.

All of us however agreed that if we’d play this on the 3×3 player board, managing car parks would certainly be one of our key challenges.


The ultimate aim of the game is to have the most “popular” hospital (measured in PP Popularity Points aka VP). Each PP costs you $3 but you can only gain PP from the profits you made in each round – not from the available cash in hand. So it’s not a linear plan of optimizing everything and building an income engine early in the game to rake up as much cash as you could and then convert them all in one-go at the end of the game to PP.


Suppose I made $52 in fees this round, and after deducting operating expenses (yes hospital rooms need to be maintained, staff/doctors/nurses need to be paid), I’m left with $28 (above) as this round’s profits. I now need to decide how much of this $28 profit I wish to spend to buy PP (at $3 per PP) and the remaining would be added to my cash pool.

Spent too much on PP and you are left with too little cash to build (or pay expenses) next round. Keep too much cash and you miss out on the opportunity to convert to PP (which is all that matters at the end of the game). Money leftover at the end of the game earns you zero popularity. They are not even used as tie-breaker.

In this session, I’d $15 left at the end of the game which indicated I was not very efficient with my cashflow management. The $15 could have been converted to 5 PP if I’d managed my cashflow better. This mechanics mechanism concept (hehe) introduces yet another trade-off you need to consider in the game.


The Patient cubes are set up to create a scarcity towards the late game rounds (similar to the goods cube scarcity in Age of Steam). We found that towards the last round(s), we were fighting for scraps to admit new patients from the Service queues. This part of the game reminds me a lot of some brutal Age of Steam maps where good cubes are so scarce some players can get bankrupted if they were not prudent in their spending.

Hospital expenses still need to be paid even if you have no (or limited) income coming in so one does need to be careful of the trade-off between keeping money for cash and converting them early to PP.


My hospital at the end of the game. I built “high”; all the way to the 3rd Floor and therefore able to accommodate four different Service rooms (there are five services in the game) since you can only have one Service room in each floor of one building. There’s an end-game building bonus that rewards you for each additional floor of your hospital that contains an active Service room.


Ivan’s hospital was one of those which expanded into a 2nd building (mine was tall but only had one building). To do so you need to manage your ground floor space (and car parks) very efficiently. There’s also a building bonus (5 PP for each additional building) if you are able to expand beyond your first building.


I do not have the numbers but I think Boon Khim’s (and Dith) were the two most efficient hospitals in terms of traffic flow. Dith’s final Time Tracker stood at the lowest point (3 hr 10 min) while with Boon Khim, I noted the amount of time he spent on movement points per round were certainly much lower than mine. My final movement points stood at 4 hr 10 min – that’s an hour more than Dith or equivalent to a loss of 4 PP against him.

The game scores were very close for all four players in the final round so it’s not wrong to say every 15 min matters (since it cost 1 PP). Pay attention to your hospital’s flow.


This is certainly not Town Center, even if Alban carry over some of the 3D element of city building from that game. This is a full-blown Euro with it’s resource, cash and flow management challenges. Alban did very well to integrate the 3D building challenges into the business management elements of the game. Those who like the freshness of PANAMAX would likely enjoy the unique mechanics in play here.


It is not a light or medium game, and if played competitively can be prone to AP – but as Rahdo mentioned in his Playthrough vid, it’s AP of the enjoyable type. Shades of Age of Steam here as you can see the similarities of fighting for the right good cubes and building your railway networks to deliver those good cubes implemented in CLINIC as patient admittance and minimizing the amount of time spent to have those patients treated successfully.

We played on the kinder 4×3 player board and we can understand how difficult it’s going to be playing on the 3×3 player board. If you want a tough challenge, do a 4-player game on the 3×3 board. Parking would be a painful experience! 😛


Picture © David Zimmerman (BGG)

The base game comes with two expansions; implemented in a beautifully done Medical Dossier fomat (above). It’s a small print run from an independent game designer and reminds me of recent great games coming out from such indies or small publishers like Wildcatters, La Granja and Arkwright.

The success of Essen 2014’s very limited print run of 200 copies prompted Alban to do another limited rounds (the 2nd salve where I got my set). Let’s hope some US publishers pick this up – like Wildcatters – which would then allow more gamers to get access and enjoy this game.


Even though the game box states this is for 2-4 players, there’s a solo variant rule posted by Alban. You can check it out here


We did a 5p PANTHALOS before wrapping it up for the night but I’ll save the Panthalos sessrep for the next report. Till then you can enjoy more pictures of this meetup session from our Facebook photo album (below).


p/s It’s good to be back writing…


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3 replies »

  1. Interested to join in for some gaming sessions! Been following Hiew’s blog apart from this one and some titles which intrigue me are Clinic, Roads and Boats and Virgin Queen.

    Only started getting into the Eurogame genre half a year ago and the experience has been incredible. I game with my girlfriend and 2 other friends weekly and we play Castles of Burgundy, Puerto Rico, Municipium, T&E and Princes of Florence, all of which are excellent classics in my opinion.


  2. Dennis, if you are looking for Roads & Boats, I know a customer of mine looking to sell his. If you are keen, I can let him know. Price range should be RM400ish. Do track our meetup invites in Facebook and we hope to game with you one day. 🙂


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