I didn't get enough combat time to determine if this is definitely the case, but I certainly found it harder to finish fights without using V.A.T.S. - even with all my leet FPS skills I struggled to take out some of the opponents. Using V.A.T.S. made it pretty simple, although there's some initial weirdness because of the disconnect flipping between the free-flowing FPS mode and the cinematic V.A.T.S. mode.

The V.A.T.S. thing looks cool - some of the deaths are particularly spectacular and satisfying - but I'm not sure about the long term appeal. I found I couldn't skip some of the death animations, which I wanted to, after some casual engagements.

I also would have liked the ability to move the camera around during these engagements - at least once in close-quarters fighting the automatically selected camera angles were up way too close against the character and very awkward.
(...)
One thing that did bug me though was the jumping - it's like slow motion moon jumping or something; you just bounce in the air and can actually move through the air as well (dislike because it's just a bit of a disconnect from the gritty realism of the surrounding environment.

Another cool incident happened at a former villa. Here I met some kind of Hugh-Hefner-type dude, who was chilling with two women of easy virtue. The house was full of empty whiskey bottles and everything pointed to a rough life style. I asked the ladies what they were doing here exactly and it was clear they were only there for the money. They also let me know I'd be better off not picking a fight with the landlord, as he's extremely proficient with weapons. Cool, reason enough for me to take out my shotgun and blow his head off. A wise move, as because of his death I now had a nice machine gun, as the ladies ran off in a panic. This annoyed me and by shooting off their legs I assured neither lady could go anywhere anymore.

In all likely I could no longer do a certain quest due to this action. It turned out both ladies had a knife under their nightgown. It might very well be they had a double agenda, but now I would never find out. Actions in Fallout have real consequences and I love it.