Not very often, but there are times when I require great precision so I use the spot tool in the same way a spotting brush was used on paper prints - essentially removing/cloning out with a series of single spots. The beauty of it is that as I build each spot, I choose precisely where it is cloning from.
Users need to remember that for the most part the spot/cloning tool works brilliantly, but there are times when we, the functioning human user, needs to put some thought and effort into a cloning strategy that fits the situation. It doesn't always work the first time we try a certain strategy, so we learn/adopt other techniques.
Rant warning: By the way - that's good thing, in my opinion, as I would prefer the tool to misfire a few times to get me thinking and using rather than just pushing buttons.
It's no wonder painters just shake their heads at how photography is becoming more and more auto-push button and solve a problem!
I'm not saying this is what the OP is after, but there is a whiff of this in the conversation.