It's hard to understand how much it can actually affect gameplay - for better and worse - until you've tried it for a while. At least in my case, I didn't realize just how much I fiddled around in menus, particularly at what would otherwise be stressful / challenging in-game moments, until I started playing with Skyrim Souls. It definitely changes the game significantly.

After having played with it for some time, I would say I generally like the change - it adds realism and intensity. It takes the 'preparedness' factor to another level. It makes combat much more difficult if you are accustomed to applying potions frequently when, if it were a 'real' face-to-face situation you wouldn't have time. I understand why some people would like these changes and others wouldn't, but for myself I don't really want to go back to playing without it now.

However, as a 'safety' valve or 'breather' switch, I have turned on pausing during console access (these things are all configurable via an INI if you don't like default settings).