How do you find the right place to put your stethoscope?

September 25, 2025 •

3 min read

Learning to use a stethoscope is a fundamental skill for medical professionals and students, yet a 2013 study in The Ochsner Journal highlighted that many residents feel inadequately trained in auscultation. This guide will walk you through how to find the right place to put your stethoscope, ensuring you can accurately listen to vital body sounds.

Quick Summary

The correct placement of a stethoscope depends on the body sounds being assessed, with specific anatomical landmarks used for the heart, lungs, and abdomen. Learning these locations, along with proper technique, ensures you can accurately and effectively perform auscultation during a physical examination.

Key Points

Heart Sounds: Use the 'APETM' mnemonic (Aortic, Pulmonic, Erb's Point, Tricuspid, Mitral) to systematically auscultate the correct valve areas on the chest.
Lung Sounds: Follow a side-to-side, ladder-like pattern on both the anterior and posterior chest, listening to at least one full breath cycle at each location.
Bowel Sounds: Start in the right lower quadrant and move clockwise through all four quadrants of the abdomen to assess for peristalsis.
Bell vs. Diaphragm: Use the diaphragm with firm pressure for high-pitched sounds (lungs, heart S1/S2) and the bell with light pressure for low-pitched sounds (murmurs, bruits).
Direct Skin Contact: Always place the stethoscope directly on bare skin, as clothing can create artifact noise that interferes with accurate listening.
Acoustic Seal: Ensure your earpieces are angled forward towards your ear canals to create a tight acoustic seal and maximize sound transmission.
Quiet Environment: Perform auscultation in a quiet room to minimize ambient noise, which can obscure critical internal sounds.

Mastering the Fundamentals of Auscultation

Proper stethoscope use begins with ensuring your equipment is set up correctly. The earpieces should be angled forward to create an acoustic seal in your ear canals. If your stethoscope has both a bell and a diaphragm, rotate the stem to activate the desired side—the diaphragm for high-pitched sounds and the bell for low-pitched sounds. Always place the chest piece directly on the patient's bare skin to avoid interference from clothing.

Stethoscope Placement for Heart Sounds

Assessing heart sounds involves systematically listening over specific areas that correspond to the four heart valves. A common method uses the 'APETM' mnemonic:

The 'APETM' System

Aortic Area: Located at the second intercostal space on the right sternal border.
Pulmonic Area: Located at the second intercostal space on the left sternal border.
Erb's Point: Found at the third intercostal space on the left sternal border, good for hearing all valves.
Tricuspid Area: Positioned at the fourth intercostal space on the left sternal border.
Mitral Area (Apical Pulse): Situated at the fifth intercostal space on the left mid-clavicular line.

Stethoscope Placement for Lung Sounds

To listen to lung sounds, systematically assess both the anterior and posterior chest using a side-to-side, ladder pattern {Link: Osmosis https://www.osmosis.org/answers/auscultation}.

Posterior (Back) Auscultation

Have the patient sit up, lean slightly forward, and cross their arms to move the scapulae. Begin above the scapulae at the lung apices. Move down the back in a ladder pattern, comparing sounds at the same level on both sides. Avoid placing the stethoscope over the scapulae. Listen to at least one full breath cycle (in and out) at each spot.

Anterior (Front) and Lateral Auscultation

Continue the ladder pattern on the front, comparing sides. Listen below the clavicles for the upper lobes. Listen over the right middle lobe at the fourth intercostal space on the right mid-clavicular line. On the sides (lateral), listen in the mid-axillary line from the armpit down.

Stethoscope Placement for Bowel Sounds

Assess bowel sounds by dividing the abdomen into four quadrants and listening systematically {Link: Osmosis https://www.osmosis.org/answers/auscultation}. Begin in the right lower quadrant, moving clockwise to the right upper, left upper, and finally the left lower quadrant. If no sounds are detected, listen for up to five minutes in one area.

The Bell vs. Diaphragm: Choosing the Right Side

Selecting the correct side of the chest piece is crucial for hearing different frequencies of sounds. {Link: Osmosis https://www.osmosis.org/answers/auscultation}


Feature	Diaphragm	Bell
Function	Filters low frequencies; amplifies high-pitched sounds.	Filters high frequencies; amplifies low-pitched sounds.
Application	Lungs (breath sounds), Heart (S1/S2), Abdomen (bowel sounds).	Heart (murmurs), Arteries (bruits).
Technique	Apply firm pressure.	Apply light pressure.

Key Techniques for Successful Auscultation

Bare Skin: Always place the chest piece directly on the skin to prevent artifact noise.
Quiet Environment: Minimize distractions and noise for accurate listening.
Systematic Approach: Follow a consistent pattern for thorough assessment.
Patient Breathing: Ask patients to breathe slightly deeper through their mouth for lung sounds.
Warm Chest Piece: Warm the chest piece in your hand for patient comfort.

Conclusion: Practice Makes Perfect

Learning how do you find the right place to put your stethoscope is a skill that improves with practice. By understanding anatomical locations and using the correct technique for the bell and diaphragm, you can confidently auscultate the heart, lungs, and abdomen. Consistent practice will hone your ability to detect subtle sounds important for patient assessment {Link: Osmosis https://www.osmosis.org/answers/auscultation}. For a deeper understanding of heart sounds, consult resources like the guide from Practical Clinical Skills.

Frequently Asked Questions

To find the correct placement for heart sounds, follow the 'APETM' pattern: Aortic (right 2nd intercostal space), Pulmonic (left 2nd intercostal space), Erb's Point (left 3rd intercostal space), Tricuspid (left 4th intercostal space), and Mitral (left 5th intercostal space, mid-clavicular line).

For lungs, use a systematic, ladder-like pattern, listening on both the anterior (front) and posterior (back) of the chest. On the back, listen between the scapulae, and on the front, listen below the clavicles and over the lateral sides.

For bowel sounds, start in the right lower quadrant of the abdomen, then move clockwise to auscultate the right upper, left upper, and left lower quadrants. The right lower quadrant is the location of the ileocecal valve and often has audible sounds.

You should always place the stethoscope's chest piece directly on bare skin. Clothing, even thin fabric, can create static and friction noises that can obscure or distort internal body sounds, making your assessment inaccurate.

The diaphragm is the larger, flat side used for high-pitched sounds, like normal heart sounds and breath sounds, and requires firm pressure. The bell is the smaller, concave side used for low-pitched sounds, like heart murmurs, and requires light pressure.

To ensure proper positioning, the earpieces should be angled forward, pointing towards the tip of your nose, when you insert them into your ears. This aligns with your ear canals and creates an acoustic seal that blocks out external noise.

If you hear nothing, first check that the earpieces are inserted correctly and that the active side (diaphragm or bell) is properly indexed by twisting the chest piece stem until you hear a click. The environment should also be quiet, and the stethoscope placed firmly on bare skin.