The next time I played it was after the patch, it played and worked fine, I played about 5 hours or so. No problems.
Last weekend I had some free time so I played a little more. This time I experienced the following issues in a short period of time of re-loading the game several times.
- Crash after loading saved game.
- Sudden reduction in frame rate to almost zero.
- Crash on loading levels.
- Crash with alt-tab.
- Weird audio issues.
After experiencing these issues they all suddenly went away just as mysteriously as they had appeared. I played for several hours with no issues after that.
Essentially the game was working fine, it suddenly decided to not work fine, and then it worked fine again. I did nothing to fix the game, I just force closed the application and tried again. Nothing on the computer changed. The computer is only turned on for me to play games and it stays off for the rest of it's existence. I installed no applications, and made no changes to the game.
If you're having problems, there may be nothing that you can do to fix it. You can waste away your time playing and tinkering with drivers, DLLs, config files, and complaining about a patch delivery, and still get no where.
There is a support link on Bethesda's site that you can use to report issues that you're having with the game: http://support.gamesas.com/eng/products.asp
It may be a better option for them if they have an internal ticket system where they can manage and categorize the issues and collect data. It's probably a lot easier than sifting through the numerous forum posts for good info.