Combat and gameplay are fine, quests are good, story is fun, world building is cool. Only problems with Bethesda games are generally slightly below standard graphics an bugginess. Neither matters too much.
I've only played about 6 hours but the side quests seem really good so far. Exploring is also better than I expected as there a lot of enter able ruined houses etc. The pacing on the main quest seems a bit off though. Only about 2 hours in and you already kill a deathclaw in powerarmor.