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How far away do you find you have to sit?

You dont. At 42 inches a 4k screen is basically four perfectly aligned 21 inch HD panels. Don't think 4k for smooth fonts and "retina" style pixel density. Think of it in terms of screen real estate.

Sitting an arms-length away, I'm just imagining a lot of head movement going from the bottom (dock or taskbar) to top (menu bar or window title bar). Any tips? Maybe it works if you put only less-frequently-used windows up high.

I've used a 30" display (at arms-length), and it felt nice, but already rather tall.

This is really interesting but yeah it almost seems like overkill for my use case! However I may be editing some 4K video too in the future (from a drone) so maybe this is the way to go.

Anyone have any issues driving one of these from a MBP?

I had but then I got a mini display port 1.2 to HDMI 2.0 active converter and that fixed the colours and fineness and best of all runs @ 60Hz