Just by way of contrast, I am having very few problems. I have a fairly high end system -- dual core, 4GB Ram (Effective 3GB with Windows XP), 2.6 ghz, ATI Radeon 4870. Not top end, but I can play any game out there. I have NV maxed out. I see the occasional stutter-step, once in a while the sound is out of sync, twice a character seemed invulnerable to either energy weapons, bullets or shotgun--I couldn't kill him. I crashed four times in 12 hours of play.
Otherwise, the game is smooth, the voice acting IMO is excellent, the look and feel is enough like FO3 and different enough to make this great, and I think the writing so far is great too. Each quest so far has started off seemingly dull ("go find a rocket thruster") and turned out to be really really good.
I do save frequently--no, more like an obsession

I always choose Load not Continue...why? A few times I chose Continue and ended up in a really early save.
I doubt if all the people who have minimal problems are posting here, so I thought I'd chime in. A robust patch is sorely needed. I have beta-tested two other big games, and this one is in bad shape by comparison, and there is no disputing that or excusing that. IMO, since consumer money is tight, they wanted a piece of the Christmas money before Christmas shopping kicked into high gear.
Merry Christmas.