Hotkeys work fine for me. I have 7 items hot keyed, and all arrive promptly with a press of the appropriate number key. May I suggest you look closely at the manual that accompanies the DVD? Bottom of page 7 under the heading "Favorites".
I didn't intend to imply that hotkeys weren't in. I fully understand the system.
What I had intended to express is that through the items and magic menus, where you can equip and unequip things for different hands, you need to jump through a couple of hoops. For instance, lets say you had a lightning spell in your left and and a healing spell in your right. It is not possible, through the magic menu, to change the healing spell in your right hand through the use of the magic menu. For whatever reason, the right hand can not be traded out through that menu for a different spell. It will just flip between R and RL, back and forth.
Instead, you have to go to the item menu to equip a weapon and then unequip the weapon and then choose the spell for the right hand and then choose the left. It's either that or use hotkeys. However, since there are a limited amount of hotkeys and a ridiculous amount of awesome spells and shields and effects, the limited amount of hotkeys is not enough and you end up having to jump through hoops every once in a while.
Do you understand what I'm saying now?
Either way, try it out for yourself. People that might stick to a few things might not even notice. I like to play it on the hardest difficulty and so I end up having to switch things often to give myself even the tiniest edge.