I got a couple of hours in with FO4 last night. So far, it is very much like FO3, but for me this is not a bad thing. The graphics are updated a bit, with a more varied palette, but I have not seen anything astonishing just yet. I have heard there are some clipping (all versions) and framerate (consoles) issues, as well as the occasional crash (mostly PC), but have not yet experienced any problems on my PS4 version.
The new VATS system was the most jarring change for me. The first time I had to use it was when I was confronted with half a dozen radroaches in a narrow corridor, with a couple of them flying at me quickly. Using VATS no longer pauses the game, but instead simply slows it down. As I was struggling with targeting the correct roach, and the specific body part I wanted to target, the first couple of roaches got to me and did some damage. I finished the encounter in real time mode, and was cursing the VATS system. I am still coming to grips with it, and if I don't start targeting in VATS quickly enough, I still end up with enemies hitting me in melee before I can take them down. That said, I still use VATS when I have the AP for it, because I am terrible at FPS combat. I am hoping I adjust to the new system before it becomes too frustrating for me.
The next unexpected change was the removal of the skill system from SPECIAL. It is all attributes and perks now, but there are a metric shit ton of perks to choose from. It is almost overwhelming, but the perks you can choose are limited by your attributes. Every time you level up, you can choose to assign a point to an attribute, or a perk (perks have multiple levels now). I built my character with a high Intelligence, expecting to be able to use this to quickly pump up skills, so I was a bit disappointed to find that there were no skills. On the other hand, a high intelligence translates to bonus XP, so my choice should still pay off in the long run, allowing me to level up more quickly, and choose more perks.
Companions are much improved. First of all, they can't be killed. That was my problem with companions in FO3, my companions never lasted long, and I was often the reason why they died, having accidentally killed them myself. The most often heard muttered phrase from me when wandering the wasteland with a companion was "Silly bitch, that'll teach you to get in my way!" Beyond not being able to die, they are also more controllable. You can tell them exactly what to equip, and what to do.
Dialogue trees are also an improvement over FO3. You get a couple of direct responses, as well as options that are just general tone like "sarcastic", so you know a bit better how what you are going to say is going to come out. On the other hand, you only ever have 4 responses, and from what I have heard NPCs are not as sensitive to your dialogue as they were in New Vegas.
The new crafting system seems intriguing. In addition to building and upgrading weapons, armor, food, and drugs, you can now build entire settlements, and virtually everything you find in the wasteland is usable in crafting. I have not yet started crafting yet, but have found crafting stations in numerous locations already. I think it will become a big part of the game for me, as I am often a sucker for crafting, especially when the options are this varied.
All in all, I am loving the shit out of it, and do not regret picking it up early at all. I just hope I will still feel the same a month from now. The Fallout series has never disappointed me as far as wasting vast amounts of my time.