Try to reduce your in-combat tanking macros to two or three buttons. You can have as many out-of-combat macros and buttons as you want (for example your pulling macro) but if you're trying to control healing, DPS, and tanking, then you don't want too many options with the tank. For pally tanking I really just spam 'a' the whole fight... if someone grabs aggro I push 'shift-a'. Similar with my DPS (two buttons) and healer (three buttons).

You can still have the revenge and shield slam alerts, but the goal is to reduce complexity as much as possible while maximizing TPS and utility.