Receiving negative performance feedback can elicit negative emotional reactions which can interfere with feedback acceptance and use. This study investigated emotional responses of family physicians' participating in a multi-source feedback (MSF) program, sources of these emotions, and their influence upon feedback acceptance and use.The authors interviewed 28 volunteer family physician participants in a pilot study of MSF, purposefully recruited to represent the range of scores. The study was conducted in 2003-2004 at Dalhousie University.Participants' emotional reactions to feedback appeared to be elicited in response to an internal comparison of their feedback with self-perceptions of performance. Those agreeing with their feedback; i.e., perceiving it as generally consistent with or higher than self-perceptions responded positively, while those disagreeing with their feedback; i.e., seeing it as generally inconsistent with or lower than self-perceptions, generally responded with distress. For the latter group, these feelings were often strong and long-lasting. Some eventually accepted their feedback and used it for change following a long period of reflection. Others did not and described an equally long reflective period but one which focused on and questioned MSF procedures rather than addressed feedback use. Participants suggested providing facilitated reflection on feedback to enhance assimilation of troubling emotions and interpretation and use of feedback.Negative feedback can evoke negative feelings and interfere with its acceptance. To overcome this, helpful interventions may include raising awareness of the influence of emotions, assisting recipients to focus their feedback on performance tasks, and providing facilitated reflection on feedback.