Guess it's a playstyle thing - I've been playing PC games for decades, too.... and I've still got no idea what people do with all those quickbars and/or how they keep track of them all.
Obviously I can't speak for others, but I tend to key up something like this for a physical fighter:
1) Weapon one. Usually for a max damage melee weapon
2) Weapon two: A reserve weapon in case of a draugr shouting my main weapon out of my hand. This is also usually the soul-trap weapon.
3) Ranged weapon or spell
4) I've taken to using this as a shield select, as I tend to spell with the left for melee builds. Can also be a cloak/ward if playing a caster.
5) Main healing spell
6) Sneak/muffle spell
7) Varies from game to game and onplay style, but usually a spell or shout
8) A spell to provide light, or a torch.
Thats for a melee fighter. There are variations, but I try to keep to something similar so I know what every hot key probably does. Yes, I could use the pause and menu, but I find it immersion breaking. Personally I'd like at least two more hot heys, or better yet, four. Playing caters in particular I'd like a lot more spells hot-keyed. The only time I have no issue with the available number is if I'm RPing a 2H pure melee character whgo never uses magic.