None of my medium format cameras do have a meter built in. One of my medium format cameras has a meter in the accessory prism finder.

I have never used a true spot meter.

I have four 35mm cameras with a choice of metering patterns - including one pattern that is fairly concentrated around the centre focussing aid.

The medium format camera that has a meter in the accessory prism finder also offers a choice of metering patterns - including one pattern that is fairly concentrated around the centre focussing aid.

I don't always use the meter in the cameras that have them.

I do use a simple, small and relatively inexpensive hand meter in incident mode a lot.