I use a Wacom tablet all the time, on every system I use. I travel with a Wacom when I'm working out of my office.
I don't use the default settings. I actually use the same pen buttons as you: Right Click on the top of the switch, and Pan/Scroll on the bottom. If you're using Hover Click, try Click & Tap -- that's my overwhelming preference. Hover click feels very imprecise to me, whereas click and tap always does what I want it to.
No matter what settings you choose, using a tablet feels weird and slow and awkward for a week or two, but once you've used it for a while, you will become much more natural and speedy.
A couple other notes: For some specific apps, I'll change the lower switch to Middle-click as others have suggested. Also, Robert's tip to turn off Windows Ink is vital. I don't have much trouble double-tapping manually for a double-click, and I find normal tablet mode (vs. mouse mode) is perfectly usable on 4K monitors.
Although I find the pen and tablet way more natural than the mouse, you can still get repetitive stress injuries, because if you tablet full-time, you'll still have repetitive stresses! I also keep a Kensington Slimblade Trackball on my workstations. It's very easy to use, and you can actually twist the trackball clockwise or counterclockwise to scroll. I bounce back and forth between the two input devices all day.
Good luck,