This is what I put on my website with regards to the use of the word Realism in my mod (it was written for Fallout 3, but it applies just as much to New Vegas):
"Oh, before you get the wrong idea of what I mean by "realism" (I should never have put that word in the title!) . . . it is NOT, and never was, my intent to make FO3 a more realistic combat simulator (but it does greatly enhance combat). By 'realism,' I mean more immersive and more realistic within the context of Fallout's alternate reality (which is a place where radiation causes mutations as often as death, and where you can be healed with a stimpak injection)."
And in my Fallout 3 Journal's "Trials of a Wasteland Wanderer" (at the end of Chapter 2):
"The game takes place an alternate reality that sort of follows our historical time line until the 1950s (in the real world). From that point on, the two worlds took very different paths. Because of this, the Fallout world of 2077 was completely different from what our own would might be like in 67 years. In order to really immerse yourself in the game, you have to understand some of these differences, or you will keep running up against inconsistencies which will pull you out of the immersion that is such a necessary part of role-playing.
A game like Fallout that mirrors our world can actually be more difficult to role-play than a game like Oblivion, where you are obviously in an alternate reality. At first it seems like the Fallout game world is a 1950s version of our world, like they sort of got stuck in that era and never progressed. But then you run up against technological advances like PipBoys (which are a lot like very large, industrial-looking iPods) and hovering robots. The game begins in the year 2277, but technology has essentially been at a standstill for 200 years, so the game world is centered around the remains of an alternate reality that was mostly destroyed in 2077.
The easiest way for me to get my head around this alternate reality is to think of the Fallout world of 2077 as a future that people living in 1950 may have imagined their world to be like in 125 years. It sort of mimics the world of Buck Rogers, Flash Gordon, and perhaps even a bit of the original Star Trek series. This is a reality where radiation causes mutations as often as death, and where most injuries can be healed in just a few seconds with a simple stimpak injection."
If you cannot wrap you head around the fact that the game is not based on this reality, you should uninstall the game and find a game that requires a bit less imagination.
I've ALWAYS stressed that my goal in to make Fallout a better Role-Playing Game! In a RPG, your skill level determines your success in combat, not how fast you can punch a button.
Plus I have made it very clear that my current version is still an early release. I haven't even touched explosions or individual weapons yet. My fist module is not even finished yet, and I plan on having 4 modules.
*** Sorry for the rant, but this is the sort of attitude that makes me wonder why I even bother with a public release . . . it would be MUCH easier if I just made my Tweaks for my own use.