It's not exactly the same.
For example in Skyrim you can open the hardest locks with no skill at all. Just plenty of lockpicks and some trying. Here you cannot attempt lockpicking at all unless you have the perk that allows you to try to open it to begin with.
It doesn't have to be super hard. This isn't a dexterity game but an RPG so someone may have very svcky dexterity IRL and is unable to actually do it but he wants to play a sneaky thief so perks help with fulfilling that fantasy.
Keep in mind this isn't a post-apo simulator game.
PS
Sell excessive chems and that's that
What? Don't sell the chems, cook them and make new ones for XP points!
+1.
Psychojet is amazing. Two hits of it and I downed a glowing deathclaw without being hit by it.
That is awesome! I'm not that far gone yet that I met any death claws at all but the XP really helps my progress.
Also, I collect a lot of meat from animals and cook it too since it gives better XP than killing the animals.
Survival is literally the same as very hard but your healing is limited. If you're high level with relevant perks you still one shot most enemies with a headshot.
Chems are very useful, considering that they can buff your stats dramaticallly. Make chems sell the bad ones, and generally make them for the XP. Chems also can be useful in buffing stats for that few extra point.